The Colorado Department of Public Health and Environment (CDPHE) was notified that an adult male who traveled to the Denver Metropolitan Area from India on May 14th and developed a febrile rash illness on May 23rd has tested positive for measles at the CDPHE Laboratory.

While infectious, the patient was hospitalized at Sky Ridge Medical Center.

Individuals being seen with a rash illness and fever should be assessed for measles. Immediately report all suspect measles cases to Denver Public Health (303-602-3614) or CDPHE (303-692-2700. After-hours call: 303-370-9395). Do not wait until laboratory results are available before reporting suspect measles cases.

INFORMATION AND RECOMMENDATIONS:

The incubation period for measles ranges from 7 – 21 days, thus susceptible individuals exposed to this person could develop measles symptoms between May 26 and June 17. People directly exposed to this person are being contacted but the measles virus is very contagious and unidentified exposures may exist. There are currently no reports of secondary measles cases; however, if secondary cases occur and remain undetected, then a third generation of cases may occur, extending the date that possible cases might present until July 8.

The diagnosis of measles should be considered in any person with a generalized maculopapular rash and a fever, especially if accompanied by cough, coryza, or conjunctivitis (immunocompromised patients may exhibit an atypical rash or no rash). Suspected measles patients (i.e., persons with febrile rash illness) should be removed from emergency department and clinic waiting areas as soon as they are identified. In CLINIC settings, patients with suspected measles should be quickly placed in a private room with the door closed and asked to wear a surgical mask, if tolerated. The exam room should not be used for 2 hours after the suspect measles patient leaves.

As of June 4, 2013, multiple western states continue to investigate a hepatitis A outbreak associated with frozen berry mix consumption. In Colorado, 12 cases are under investigation. It is likely the case count will continue to increase.

On June 3, 2013, Townsend Farms Inc. announced that it has voluntarily recalled certain lots of its frozen Organic Antioxidant Blend because it has the potential to be contaminated with hepatitis A virus. This product was sold at Costco stores under the product name Townsend Farms Organic Antioxidant Blend – 3 pound bags, and Harris Teeter stores under the product name Harris Teeter Organic Antioxidant Berry Blend - 10 ounce bags (Harris Teeter stores are located in east coast states).

UPDATE Regarding post-exposure prophylaxis (PEP):

The recommendation for using hepatitis A vaccine for PEP has been expanded to include persons aged 6 months and older (rather than 12 months and older). Infants between 6 months and 12 months of age who receive a single dose of single antigen hepatitis A vaccine for PEP will still require the routine 2 dose series of hepatitis A vaccine starting at 12 months of age or greater if long term immunity is desired.

The efficacy of combined hepatitis A virus / hepatitis B virus vaccine (e.g., Twinrix) for PEP has not been evaluated, so single antigen hepatitis A vaccine is recommended.

Pregnant women and breastfeeding mothers may be given the hepatitis A vaccine for PEP.

Regarding hepatitis A testing:

Testing is not recommended for asymptomatic persons, EVEN IF THEY CONSUMED THE IMPLICATED PRODUCTS, as false-positive hepatitis A IgM antibody results commonly occur.

Suspect cases of hepatitis A should be reported to Denver Public Health (303-602-3614) or CDPHE immediately (303-692-2700 during business hours or 303-370-9395 after hours).